Aphagia
Inability or refusal to swallow, often life-threatening.
Aphagia is the inability or refusal to swallow, derived from Greek roots meaning 'not' and 'to eat.' It is an extreme, life-threatening form of dysphagia and may be temporary or long term depending on the affected organ. Untreated dysphagia can progress to aphagia.
Quick Facts
- Field
- Gastroenterology
- Complications
- Malnutrition, metabolic disorders
Facts from the source article.
Behavioural classification
Studies on rats with lesions in the lateral hypothalamus identified three types of behavioral aphagia. In passive aphagia, the animal does not respond to presented food but will chew if food is placed in its mouth. Active aphagia involves complete rejection: the animal pushes food away, moves its head, may sample then spit out food, and shows repulsion as if the food is bitter. Mixed aphagia begins with no reaction, but when food is placed in the mouth, the animal spits it out and refuses to eat. These studies indicate the hypothalamus regulates food intake. Other observed eating behaviors in animals with minor or no hypothalamic damage include weak eating, good eating, and vigorous eating.
Causes
Aphagia usually results from various diseases or medical treatments. Common causes include esophageal cancer (squamous cell or adenocarcinoma), esophageal webs causing constrictions, globus pharyngeus, myasthenia gravis (associated with an enlarged thymus), facioscapulohumeral muscular dystrophy (with minor esophageal dysmotility), multiple sclerosis, chemotherapy-induced throat strictures, stroke (leading to aspiration pneumonia in elderly), and Parkinson's disease (related to extrapyramidal and autonomic disorders). Damage to the lateral hypothalamus can also cause aphagia. Other possible causes include depression, cervical spine disease, and conversion disorders. Most causes except lateral hypothalamus damage are indirect.
Diagnosis
A bedside swallow evaluation assesses dysphagia by examining swallowing muscles and the patient's ability to swallow different substances, helping determine aspiration risk. This fast, low-risk test can identify stroke, dental problems, neurologic disorders, and muscular dystrophies. A modified barium swallow (videofluoroscopic swallow) uses lateral video X-rays with barium to evaluate bolus transport, safe consistency, and head positioning, identifying abnormalities such as cancer, hiatal hernias, structural problems, enlarged veins, and muscle disorders. Esophagogastroduodenoscopy (EGD) uses an endoscope to visualize the upper GI tract, diagnosing conditions like GERD, strictures, esophageal varices, or ulcers, and can treat bleeding or remove growths. Esophageal manometry measures pressure in the esophagus and sphincters to diagnose achalasia, diffuse esophageal spasm, and scleroderma.
Treatment and compensatory techniques
Treatment focuses on adequate nutrition and hydration. Diet modifications include thickening liquids (nectar, honey, or pudding thick) or altering solid food texture to reduce chewing needs. In severe cases, nasogastric (NG) or percutaneous endoscopic gastrostomy (PEG) tubes may be placed. Compensatory strategies include reducing bolus size and postural adjustments like chin tucking or head turning. A speech-language pathologist evaluates and treats aphagia, recommending strategies based on the deficit's cause and location. True treatment involves neuromuscular re-education through pharyngeal strengthening exercises, thermal stimulation, and oral motor exercises. Neuromuscular electrical stimulation (NMES) may also be used, applying low-level currents via surface electrodes to target swallowing muscles.
More in Symptoms and Signs: Digestive System and Abdomen
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